Raise young adults’ awareness about EC

Initial success seen in Boulder, CO, program

What can you do to lower the incidence of unintended pregnancies in young people ages 18 to 24? The Boulder (CO) County Health Department reports that it’s receiving a good response to an innovative emergency contraception (EC) awareness campaign.

While officials estimate some 39% of all pregnancies in the county are unintended, the numbers climb sharply when looking at women ages 18 to 24, says Alison Smith, MPH, coordinator of the department’s unintended pregnancy pilot project. Nearly 70% of pregnancies among those young adults are unplanned, she reports.

While the pilot program is still in its infancy, health department officials are encouraged by the response to the posters and handout cards in young adult gathering sites that highlight EC availability. During the height of the campaign, the number of students visiting the University of Colorado-Boulder Wardenburg Health Center for EC doubled from the same month a year ago, says Smith. Because numbers were the same for the preceding two months in both 1999 and 2000, officials believe the target audience is indeed hearing the message.

The program is funded by a $10,000 allocation of federal maternal and child health dollars awarded by the state, says Smith. If the pilot program proves successful, health department officials hope to gain additional grant money to expand its scope.

Much effort traditionally has gone into adolescent pregnancy prevention programs. Given the high rate of unintended pregnancy among the county’s young adults, health department officials knew they would have to use a somewhat different approach in reaching the older population.

Young adults who had experienced an unintended pregnancy were gathered in focus groups to determine the causes and identify effective prevention strategies. Findings showed that among that population, casual sex is a cultural norm, often occurring with no preparation for protection against pregnancy or sexually transmitted diseases (STDs), says Smith. Because young adults are generally a healthy population, many do not regularly seek preventive care services and are more likely to access health care in an emergency, she points out.

Acknowledging the unfortunate reality of those behaviors, health department officials determined that a campaign informing young adults about EC would be the most effective approach, says Smith. By bringing young adults to the health care facilities who otherwise would not come, the door would be open to discuss ongoing contraceptive methods. "Anyone who comes into the clinic for EC is going to get full information about finding a more ongoing reliable method of contraception," she observes. "We are hoping that this will be a way to encourage people to utilize health care services and then, in turn, get them on a more long-term method."

Young adults want information and services at locations where they congregate, according to a finding from the focus group. A number of sites were selected, including the university recreation center, restaurants, and bars. Copies of two posters — one for females and the other for males — were placed in bathrooms at the selected sites, along with take-away information cards. Student volunteers were enlisted to distribute material to university sororities and fraternities and university student mailboxes. Volunteers also acted as field surveyors, conducting polls outside the targeted poster areas to determine the effectiveness of the awareness campaign.

The posters and cards highlight EC’s 72-hour window of effectiveness, its mechanism of action, its inability to protect against STDs, and its cost. The cards list the addresses of three sites for EC: the student health center, Planned Parenthood of Boulder, and Boulder Valley Women’s Health Center. Each of the sites is collecting data on the reason behind each EC visit and how each woman learned about the method.

The campaign began with a front-page story in the student newspaper about the addition of Plan B (the levonorgestrel ECP from Women’s Capital Corp. of Bellevue, WA) to the student pharmacy. The story informed students who knew about EC only as the "morning-after pill" of the method’s 72-hour window, as well as the decreased side effects associated with the progestin-only pill.

Many of the students who discuss EC with Judy Buck, RN, a women’s health nurse at the university’s health center, say they saw the poster or cards. While many of them may have known about EC, they may not have known it was easily accessible at the health center, she notes.

Many students confuse EC with the abortion drug RU-486 (mifepristone), says Buck. She carefully explains the method’s mechanism of action and assuages fears that EC may hinder future pregnancies.

"When I talk to them and hear their history, I generally am very supportive that it was a very good thing to come in and learn more about EC," she says. "I try to be very sensitive to the different situations that are presented, then I go over what EC is and how it works. Often, just hearing about what it is and how it works dispels a lot of myths."

She also explains that while Plan B is a new brand, EC has been safely and effective used by millions of women. "A lot of people come in and say, I’m so glad this is finally available,’" she says. "ECs have been available for about 25 years, which makes them feel better about this not being something new and bizarre that has not been completely explored."

Alison Smith, MPH, Coordinator, Unintended Pregnancy Project, Boulder County Health Department, 3450 Broadway, Boulder, CO 80304. Telephone: (303) 441-1530. Fax: (303) 441-1452. E-mail: axshe@co.boulder.co.us.